Given the heterogeneous nature of breast cancer, biomarkers evaluated throughout treatment help provide a clearer picture of the treatment paradigm.
Given the heterogeneous nature of cancer, biomarkers evaluated throughout treatment help provide a clearer picture of the treatment paradigm and disease progression, thereby facilitating optimal oncology care. For breast cancer, diagnostic tissue, histologic, prognostic, and predictive biomarkers—both standard and investigative—enable individualized treatment and maximum patient benefit.
A new review published in Virchows Archiv explores a variety of these biomarkers, focusing on recent updates and testing guidance from the College of American Pathologists/American Society of Clinical Oncology (CAP/ASCO) for estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) cancers.
“In breast cancer, the last several decades have seen an evolution from providing basic tissue diagnosis to include a comprehensive list of not only histologic biomarkers but protein-expression–based and molecular prognostic and predictive biomarkers,” the authors explained.
With new data indicating that low ER–expressing cancers may have different characteristics than high ER–expressing cancers—since the 2010 CAP/ASCO guidance on ER and HER2 receptors—the new guidance officially acknowledges ER-positive carcinoma with low ER expression as a category of invasive breast cancer. The cancer has gene expression profiles and clinical course profiles similar to ER-negative cancers.
In addition, because some features of ER low–positive cancers may indicate aggressive biology, such as with ER-negative cancers, the new guidance recommends including a standardized comment if reporting on low ER cancers. Doing so, the authors note, “opens the door for other aspects of treatment to be tailored to those considered appropriate for ER-negative cancers.”
Labs are also encouraged to create standard operating procedures to reconfirm ER-low results since this type of cancer is still a rare occurrence, and testing for ER status among patients with ductal carcinoma in situ (DCIS) is now recommended following the NSABP B-24 trial showing that patients with ER-positive DCIS treated with lumpectomy, radiation, and tamoxifen have a lower risk of invasive carcinoma.
The newest guidance also discusses fine-tuning HER2 testing by encouraging standardizing and reporting on results. This stems from previous updates to HER2 testing guidance from 2013 and 2018 that addressed discordant HR testing results seen between central and local labs in several HER2 treatment trials, as well as HER2 heterogeneity and the potential of HER2-low and HER2-mutated cancers to change testing for HER2 status.
Additional guidance updates include the following:
“Existing biomarkers in breast cancer will continue to be fine-tuned and change with evolving treatment options and clinical data,” the authors determined. “In addition, new biomarkers will continue to emerge—likely both as companion diagnostics to new therapeutics and in novel forms such as artificial intelligence analysis, digital pathology, and liquid biopsy samples.”
Their findings also place a spotlight on the increasingly important role pathologists have in deciphering tissue and cancer characteristics in the face of decisions on targeted treatment for breast cancer.
Reference
Najjar S, Allison KH. Updates on breast biomarkers. Virchows Arch. Published online January 14, 2022. doi:10.1007/s00428-022-03267-x
Early Involvement Critical in Treating Immunotherapy-Induced Overlap Syndrome
April 19th 2024A series of case studies reveals the importance of early diagnosis and involvement of special teams of clinicians when dealing with potential cases of overlap syndrome, which encompasses myocarditis, myasthenia gravis, and immune checkpoint inhibitor–related myositis.
Read More
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
Drs Raymond Thertulien, Joseph Mikhael on Racial Disparities in Multiple Myeloma Care Access
December 28th 2023In the wake of the 2023 American Society of Hematology Annual Meeting and Exposition, Raymond Thertulien, MD, PhD, of Novant Health, and Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, discussed health equity research highlights from the meeting and drivers of racial disparities in multiple myeloma outcomes.
Listen
Real-World Study Reveals Key Insights Into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More